Publications by authors named "Ali Taghizadieh"

29 Publications

  • Page 1 of 1

The First Use of Face Mask in the History of Medicine.

Infect Control Hosp Epidemiol 2021 Apr 7:1-7. Epub 2021 Apr 7.

Department of Community Medicine, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.

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http://dx.doi.org/10.1017/ice.2021.157DOI Listing
April 2021

Comparison of losartan and amlodipine effects on the outcomes of patient with COVID-19 and primary hypertension: A randomised clinical trial.

Int J Clin Pract 2021 Mar 1:e14124. Epub 2021 Mar 1.

Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Controversy exists regarding the drug selection in hypertension (HTN) management in patients with COVID-19. This study aimed to compare the effects of losartan and amlodipine in patients with primary HTN and COVID-19.

Methods: In this randomised clinical trial, hospitalised patients with COVID-19 and primary HTN were enrolled in the study. One arm received losartan, 25 mg, twice a day and the other arm received amlodipine, 5 mg per day for 2 weeks. The main outcomes were compare 30-day mortality rate and length of hospital stay.

Results: The mean age of patients treated with losartan (N = 41) and amlodipine (N = 39) was 67.3 ± 14.8 and 60.1 ± 17.3 years, respectively (P value = .068). The length of hospital stay in losartan and amlodipine groups was 4.57 ± 2.59 and 7.30 ± 8.70 days, respectively (P value = .085). Also, the length of ICU admission in losartan and amlodipine group was 7.13 ± 5.99 and 7.15 ± 9.95 days, respectively (P value = .994). The 30-day mortality was two and five patients in losartan and amlodipine groups, respectively (P value = .241).

Conclusions: There was no priority in losartan or amlodipine administration in COVID-19 patients with primary HTN in decreasing mortality rate, hospital and ICU length stay. Further studies need to clarify the first-line anti-HTN medications in COVID-19.
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http://dx.doi.org/10.1111/ijcp.14124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995089PMC
March 2021

Letter to the editor regarding: "Cannabis and its constituents for cancer: history, biogenesis, chemistry, and pharmacological activities".

Pharmacol Res 2021 Feb 3:105477. Epub 2021 Feb 3.

Department of History of Medicine, School of Traditional Medicine, Tabriz University of Medical Sciences, Daneshgah Street, I.R Iran. Electronic address:

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http://dx.doi.org/10.1016/j.phrs.2021.105477DOI Listing
February 2021

Comments on the Story of the Silent Killer, a History of Hypertension: Its Discovery, Diagnosis, Treatment, and Debate.

Curr Hypertens Rep 2021 Feb 3;23(2). Epub 2021 Feb 3.

Department of History of Medicine, School of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, 5165665931, Iran.

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http://dx.doi.org/10.1007/s11906-020-01122-5DOI Listing
February 2021

Letter to the editor regarding: "Cupping on ancient Greek coins: A numismatic case series and its relationship to dermatology".

Clin Dermatol 2020 Nov - Dec;38(6):770. Epub 2020 May 26.

Department of History of Medicine, School of Traditional Medicine; Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address:

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http://dx.doi.org/10.1016/j.clindermatol.2020.05.019DOI Listing
May 2020

Incidence of symptomatic venous thromboembolism following hospitalization for coronavirus disease 2019: Prospective results from a multi-center study.

Thromb Res 2021 02 11;198:135-138. Epub 2020 Dec 11.

Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Thrombosis and pulmonary embolism appear to be major causes of mortality in hospitalized coronavirus disease 2019 (COVID-19) patients. However, few studies have focused on the incidence of venous thromboembolism (VTE) after hospitalization for COVID-19.

Methods: In this multi-center study, we followed 1529 COVID-19 patients for at least 45 days after hospital discharge, who underwent routine telephone follow-up. In case of signs or symptoms of pulmonary embolism (PE) or deep vein thrombosis (DVT), they were invited for an in-hospital visit with a pulmonologist. The primary outcome was symptomatic VTE within 45 days of hospital discharge.

Results: Of 1529 COVID-19 patients discharged from hospital, a total of 228 (14.9%) reported potential signs or symptoms of PE or DVT and were seen for an in-hospital visit. Of these, 13 and 12 received Doppler ultrasounds or pulmonary CT angiography, respectively, of whom only one patient was diagnosed with symptomatic PE. Of 51 (3.3%) patients who died after discharge, two deaths were attributed to VTE corresponding to a 45-day cumulative rate of symptomatic VTE of 0.2% (95%CI 0.1%-0.6%; n = 3). There was no evidence of acute respiratory distress syndrome (ARDS) in these patients. Other deaths after hospital discharge included myocardial infarction (n = 13), heart failure (n = 9), and stroke (n = 9).

Conclusions: We did not observe a high rate of symptomatic VTE in COVID-19 patients after hospital discharge. Routine extended thromboprophylaxis after hospitalization for COVID-19 may not have a net clinical benefit. Randomized trials may be warranted.
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http://dx.doi.org/10.1016/j.thromres.2020.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836837PMC
February 2021

Accountability in medical education from theory to practice Tabriz 2018 statement: A step towards the implementation of this social necessity.

Med J Islam Repub Iran 2020 6;34:93. Epub 2020 Aug 6.

Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.

To implement the education reform package on accountability in medical education, the Education Development Center (EDC) of Tabriz University of Medical Sciences has held the first national conference on accountability in medical education, and the present statement is the result of scientific interactions and exchanges in the conference. For implementation of the accountability in medical education, there was a need to inform faculty members and other stakeholders about their responsibility in education and health care needs. The provision of such platform was provided by holding a specialized conference on accountability in medical education by Tabriz University of Medical Sciences. Steps of preparing the draft version of the Tabriz 2018 Statement were as follow: Formation the scientific committee; Division of the responsibility for drafting the statement between various workgroups; and Preparation and primary approval of the draft of Tabriz 2018 Statement. Steps of preparing the draft version of the Tabriz 2018 Statement were: Formation of the scientific committee, Division of the responsibility for drafting the statement between the various workgroups and Preparation and primary approval of the draft of Tabriz 2018 Statement. Establishing an educational accreditation model and reviewing accreditation standards based on social accountability can be an effective step to strengthen accountability towards community needs.
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http://dx.doi.org/10.34171/mjiri.34.93DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722974PMC
August 2020

Effect of bromhexine on clinical outcomes and mortality in COVID-19 patients: A randomized clinical trial.

Bioimpacts 2020 19;10(4):209-215. Epub 2020 Jul 19.

Asthma and Airway Center, University Health Network, University of Toronto, Toronto, ON, Canada.

Bromhexine is a potential therapeutic option in COVID-19, but no data from a randomized clinical trial has been available. The present study aimed to evaluate the efficacy of bromhexine in intensive care unit (ICU) admission, mechanical ventilation, and mortality in patients with COVID-19. An open-label randomized clinical trial study was performed in Tabriz, North-West of Iran. They were randomized to either the treatment with the bromhexine group or the control group, in a 1:1 ratio with 39 patients in each arm. Standard therapy was used in both groups and those patients in the treatment group received oral bromhexine 8 mg three times a day additionally. The primary outcome was a decrease in the rate of ICU admissions, intubation/mechanical ventilation, and mortality. A total of 78 patients with similar demographic and disease characteristics were enrolled. There was a significant reduction in ICU admissions (2 out of 39 vs. 11 out of 39, = 0.006), intubation (1 out of 39 vs. 9 out of 39, = 0.007) and death (0 vs. 5, = 0.027) in the bromhexine treated group compared to the standard group. No patients were withdrawn from the study because of adverse effects. The early administration of oral bromhexine reduces the ICU transfer, intubation, and the mortality rate in patients with COVID-19. This affordable medication can easily be administered everywhere with a huge positive impact(s) on public health and the world economy. Altogether, the verification of our results on a larger scale and different medical centers is strongly recommended. IRCT202003117046797N4; https://irct.ir/trial/46969.
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http://dx.doi.org/10.34172/bi.2020.27DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7502909PMC
July 2020

Value of Canadian C-spine rule versus the NEXUS criteria in ruling out clinically important cervical spine injuries: derivation of modified Canadian C-spine rule.

Radiol Med 2021 Mar 23;126(3):414-420. Epub 2020 Sep 23.

Department of Epidemiology and Biostatistics School of Public Health, Tehran University of Medical Sciences, Poursina Ave, Tehran, Iran.

Purpose: Although, Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) criteria in ruling out clinically important cervical spine injuries have been validated using large prospective studies, no consensus exist as to which rule should be endorsed. Therefore, the aim of the present study was to compare the accuracy of the Canadian C-spine and NEXUS criteria in ruling out clinically important cervical spine injuries in trauma patients. Finally, we introduced the modified Canadian C-spine rule.

Methods: A prospective diagnostic accuracy study was conducted on trauma patients referred to four emergency departments of Iran in 2018. Emergency physicians evaluated the patients based on the Canadian C-spine rule and NEXUS criteria in two groups of low risk and high risk for clinically important cervical spine injury. Afterward, all patients underwent cervical imaging. In addition, modified Canadian C-spine rule was derived by removing dangerous mechanism and simple rear-end motor vehicle collision from the model.

Results: Data from 673 patients were included. The area under the curve of the NEXUS criteria, Canadian C-spine, and modified Canadian C-spine rule were 0.76 [95% confidence interval (CI) 0.71-0.81)], 0.78 (95% CI 0.74-0.83), and 0.79 (95% CI 0.74-0.83), respectively. The sensitivities of NEXUS criteria, Canadian C-spine, and modified Canadian C-spine rule were 93.4%, 100.0% and 100.0%, respectively.

Conclusions: The modified Canadian C-spine rule has fewer variables than the original Canadian C-spine rule and is entirely based on physical examination, which seems easier to use in emergency departments.
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http://dx.doi.org/10.1007/s11547-020-01288-7DOI Listing
March 2021

Th17 and Treg cells function in SARS-CoV2 patients compared with healthy controls.

J Cell Physiol 2021 04 14;236(4):2829-2839. Epub 2020 Sep 14.

Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

In the course of the coronavirus disease 2019 (COVID-19), raising and reducing the function of Th17 and Treg cells, respectively, elicit hyperinflammation and disease progression. The current study aimed to evaluate the responses of Th17 and Treg cells in COVID-19 patients compared with the control group. Forty COVID-19 intensive care unit (ICU) patients were compared with 40 healthy controls. The frequency of cells, gene expression of related factors, as well as the secretion levels of cytokines, were measured by flow cytometry, real-time polymerase chain reaction, and enzyme-linked immunosorbent assay techniques, respectively. The findings revealed a significant increase in the number of Th17 cells, the expression levels of related factors (RAR-related orphan receptor gamma [RORγt], IL-17, and IL-23), and the secretion levels of IL-17 and IL-23 cytokines in COVID-19 patients compared with controls. In contrast, patients had a remarkable reduction in the frequency of Treg cells, the expression levels of correlated factors (Forkhead box protein P3 [FoxP3], transforming growth factor-β [TGF-β], and IL-10), and cytokine secretion levels (TGF-β and IL-10). The ratio of Th17/Treg cells, RORγt/FoxP3, and IL-17/IL-10 had a considerable enhancement in patients compared with the controls and also in dead patients compared with the improved cases. The findings showed that enhanced responses of Th17 cells and decreased responses of Treg cells in 2019-n-CoV patients compared with controls had a strong relationship with hyperinflammation, lung damage, and disease pathogenesis. Also, the high ratio of Th17/Treg cells and their associated factors in COVID-19-dead patients compared with improved cases indicates the critical role of inflammation in the mortality of patients.
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http://dx.doi.org/10.1002/jcp.30047DOI Listing
April 2021

The First Description of Asthma Due to Heart Conditions in the History of Medicine.

Chest 2020 Aug;158(2):461-463

Department of Community Medicine, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address:

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http://dx.doi.org/10.1016/j.chest.2020.01.011DOI Listing
August 2020

COVID-19 outcomes in patients with systemic autoimmune diseases treated with immunomodulatory drugs.

Ann Rheum Dis 2020 Aug 5. Epub 2020 Aug 5.

Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran

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http://dx.doi.org/10.1136/annrheumdis-2020-218737DOI Listing
August 2020

Acute kidney injury in pregnant women following SARS-CoV-2 infection: A case report from Iran.

Respir Med Case Rep 2020 13;30:101090. Epub 2020 May 13.

Tuberculosis and Lung Disease Research Center of Tabriz University of Medical Sciences, Tabriz, Iran.

We reported a 33-year-old female case with novel coronavirus disease 2019 (COVID-19) accompanied by Acute tubular necrosis (ATN). She had a gestational age of 34 weeks. The patient referred to treatment clinic for COVID-19 in Imam Reza hospital of Tabriz (Iran) after having flu-like symptoms. In radiologic assessment, ground glass opacity (GGO) with consolidation was found in upper right lobe. Lopinavir/ritonavir (200mg/50mg) two tablet tow times, Ribavirin 200mg every 6 h, and Oseltamivir 75mg tow times were given for the treatment of COVID-19. The medications used for treatment of pneumonia were Meropenem, Ciprofloxacin, Vancomycin. All doses of medications were administrated by adjusted dose assuming the patient is anephric. Also, a few supplements were also given after ATN development including daily Rocaltrol and Nephrovit (as a multivitamin appropriate for patients with renal failure), Folic acid and Calcium carbonate. The patient is still under ventilator with a Fraction of inspired oxygen (FiO) of 60% and Positive end-expiratory pressure (PEEP) of eight. SpO is 94% but the patient's ATN problem has been resolved. We started weaning from mechanical ventilator. The patient is conscious with full awareness to time, person and place. The maternal well-being is achieved and her neonate was discharged.
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http://dx.doi.org/10.1016/j.rmcr.2020.101090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7219375PMC
May 2020

Tips for improving the quality and quantity of the extracted DNA from exhaled breath condensate samples.

Nucleosides Nucleotides Nucleic Acids 2020 14;39(5):688-698. Epub 2019 Oct 14.

Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.

There is a growing interest in the tracking of genetic and epigenetic alterations in exhaled breath condensate (EBC) samples. The effects of different procedures on the quality and quantity of DNA in EBC were studied. The results demonstrated that sodium acetate precipitation and oligo (dT) improved the quality of the extracted DNA significantly ( < 0.01). Also, sodium acetate precipitation, using oligo (dT), incubation at 70 °C and SDS treatment increased the quantity of DNA significantly ( < 0.01). These results showed the advantages of the chemical and physical manipulations for improving the quality and quantity of the extracted DNA from EBC samples.
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http://dx.doi.org/10.1080/15257770.2019.1677910DOI Listing
December 2020

Effects of Iranian healthcare transformation plan on discharge against medical advice rate and related factors in 2012 and 2016.

BMJ Open 2019 09 4;9(9):e024291. Epub 2019 Sep 4.

Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran

Objective: Discharge against medical advice (DAMA) is a critical problem in hospitals and has several consequences for healthcare systems. The aim of this study was to determine and compare the rate of DAMA and its related factors before and after executing the healthcare transformation plan (HTP) in Iran.

Methods: In a two-phase, cross-sectional study, the DAMA information of 200 patients in 2016 (after HTP) and the patients of a previous study in 2012 (before HTP) was compared. Samples were randomly selected from the main referral centre in the north-west of Iran. Data were collected using a validated and reliable questionnaire and analysed using the SPSS V.16 software.

Results: In the post-HTP plan period, the rate of DAMA was 3.9%, while this rate was 5.49% in 2012 (p=0.029). A total of 15% (108 out of 721) of patients in the postreform group and 13.5% (101 out of 747) in the prereform group were rehospitalised (p=0.411). The three main categories of reasons for DAMA in 2012 and 2016 were as follows: patient-related factors, 27% vs 45%; staff-related factors, 33% vs 30%; and hospital-related factors (basic amenities), 40% vs 25%. In both periods, the average scores of patient satisfaction were almost the same; however, satisfaction regarding environmental and human factors in hospitals had changed significantly after HTP (p<0.05).

Conclusions: There was a decrease in the rate of DAMA after HTP in Iran. Considering DAMA as a multifactorial phenomenon, this might be due to the higher relative satisfaction after HTP, indicating an increase in public confidence in general hospitals.
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http://dx.doi.org/10.1136/bmjopen-2018-024291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6731801PMC
September 2019

The PCQP Score for Volume Status of Acutely Ill Patients: Integrating Vascular Pedicle Width, Caval Index, Respiratory Variability of the QRS Complex and R Wave Amplitude.

Indian J Crit Care Med 2017 Nov;21(11):726-732

Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.

Introduction: Techniques for measuring volume status of critically ill patients include invasive, less invasive, or noninvasive ones. The present study aims to assess the accuracy of noninvasive techniques for measuring volume status of critically ill patients.

Patients And Methods: A total of 111 critically ill patients admitted to the emergency department and undergoing central venous catheterization were included in the study. Five parameters were measured including vascular pedicle width (VPW), diameter of inferior vena cava, caval index, respiratory changes in QRS, and wave amplitude. Patients with risk factors which could decrease the accuracy of central venous pressure (CVP) value were excluded from study. We compared these parameters with static CVP parameter. Finally, based on the afore-mentioned parameters, PCQP role in criteria was designed.

Results: In detecting loss of circulating blood volume, area under the curve of VPW was 0.92 (90%, confidence interval [CI]: 0.85-0.99), diameter of inferior vena cava was 0.82 (90%, CI: 0.72-0.91), caval index was 0.9 (90%, CI: 0.82-0.98), and changes in QRS and P waves were 0.88 (95%, CI: 0.81-0.95) and 0.73 (95%, CI: 0.63-0.82), respectively. PCQP role in criteria was designed according to these parameters, and at its best cutoff point (score 6), VPW had a sensitivity of 97.4% (95%, CI: 84.57-99.99) and specificity of 83.6% (95%, CI: 72.65-90.86) for the detection of loss of circulating blood volume (<8 cmHO).

Conclusion: PCQP score could be a reliable and noninvasive technique for the assessment of volume status in critically ill patients.
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http://dx.doi.org/10.4103/ijccm.IJCCM_275_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5698999PMC
November 2017

Comparison of end-tidal carbon dioxide and arterial blood bicarbonate levels in patients with metabolic acidosis referred to emergency medicine.

J Cardiovasc Thorac Res 2016 30;8(3):98-101. Epub 2016 Sep 30.

Student's Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.

The routine and gold standard method to diagnose of acid - base disturbance is arterial blood gas (ABG) sampling. Capnography could be used to measure the end-tidal carbon dioxide (ETCO2) levels and ETco2 has a close correlation with the PaCo2. The aim of this study was comparison the ETco2 and arterial blood bicarbonate levels in patients with metabolic acidosis. In a descriptive-analytical study that performed in Emergency Department of Emam Reza Medical Research and Training Hospital of Tabriz on patients with metabolic acidosis, ETco2 level and blood bicarbonate levels in 262 patients were evaluated. Mean of ETco2 and Hco3 levels in patients with metabolic acidosis were 22.29 ± 4.15 and 12.78 ± 3.83, respectively. In all patients, the significant direct linear relationship was found between ETco2 with Hco3 (r = 0.553, < 0.001). We had 4 groups of patients with metabolic acidosis, also there is a significant direct linear relationship between the ETCo2 and the Hco3 level of arterial blood in patients with renal failure ( < 0.001 and r = 0.551), sepsis ( < 0.001 and r = 0.431), drug toxicity ( < 0.001 and r = 0.856), and ketoacidosis (DKA) ( < 0.001 and r = 0.559). According to the results of this study, capnography can be used for primary diagnosis of metabolic acidosis in spontaneously breathing patients who referred to the emergency wards, however, the ABG must be considered as the gold standard tool for diagnosis and guiding the treatment.
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http://dx.doi.org/10.15171/jcvtr.2016.21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5075365PMC
September 2016

Diagnostic Accuracy of Focused Assessment With Sonography for Trauma in the Emergency Department.

Trauma Mon 2016 Sep 13;21(4):e21122. Epub 2016 Jun 13.

Emergency Medicine Department, Imam Reza Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, IR Iran.

Background: Trauma is currently the fourth leading cause of death in developed countries. One of the main objectives in abdominal trauma patients is to develop a rapid and accurate diagnosis. There is a tendency to use emergency abdominal ultrasound with abdominal trauma, therefore, it is recommended in some centers as a diagnostic tool and as a primary choice in abdominal trauma.

Objectives: The aim of this study was to determine the diagnostic accuracy of sonography for trauma by emergency medicine residents and radiology residents.

Patients And Methods: This was a descriptive and analytical study performed on patients with abdominal blunt trauma who referred to the emergency ward. The diagnostic accuracy of sonography for trauma by emergency medicine residents and radiology residents was evaluated.

Results: Of the 380 patients, 296 were males and 84 were females. The mean ages of male and female patients were 34.52 ± 16.38 years and 41.19 ± 21.38 years, respectively (P = 0.009). The sonographies performed by emergency residents were positive in 46 patients, with 22 of these confirmed by CT scans. The sensitivity and specificity of the sonography by emergency residents, as confirmed by CT scans, were 78.5% and 93.2%, respectively. The sonographies performed by radiology residents were positive in 38 patients, with 24 being confirmed by CT scans.

Conclusions: The sensitivity and specificity of the sonography by radiology residents, as confirmed by CT scans, were 85.7% and 96%, respectively. Sonographies performed by emergency residents were positive in 46 patients with 34 of these being confirmed by sonographies by radiology residents. The sensitivity and specificity of the sonographies by emergency residents, as confirmed by sonographies by radiology residents, were 89.5% and 96.5%, respectively.
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http://dx.doi.org/10.5812/traumamon.21122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958976PMC
September 2016

Diagnostic Accuracy of Chest x-Ray and Ultrasonography in Detection of Community Acquired Pneumonia; a Brief Report.

Emerg (Tehran) 2015 ;3(3):114-6

Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.

Introduction: Chest x-ray (CXR) is the simplest diagnostic tool of Community Acquired Pneumonia (CAP), but it has some limitation. Therefore, the aim of this study is comparing the diagnostic accuracy of CXR and chest ultrasonography (CUS) in detection of CAP.

Methods: In the present study, a consecutive sample of suspected patients with CAP was underwent CUS, CXR, and chest computed tomography (CT) scan. Diagnostic accuracy of CUS and CXR was assessed by calculating the sensitivity, specificity, predictive values, and likelihood ratios using SPSS 20 statistical software.

Results: 30 patients with CAP were enrolled (93.3% male with mean age of 63.8 ± 18.3 years). Sensitivity of CUS and CXR in detection of CAP were 100.0% (95% Cl: 85.4-100.0) and 93.1% (95% Cl: 75.8-98.8), respectively. Specificity of CXR was 0.0 (95% Cl: 0.0-94.5), while the CUS specificity was not calculable.

Conclusion: Findings of the present study demonstrated on the higher diagnostic accuracy of CUS versus CXR in detection of pneumonia.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608340PMC
October 2015

Effect of respiratory rehabilitation before open cardiac surgery on respiratory function: a randomized clinical trial.

J Cardiovasc Thorac Res 2015 29;7(1):13-7. Epub 2015 Mar 29.

Tabriz Health Service Management Research Center, National public health management center (NPMC), Tabriz University of Medical Sciences, Tabriz, Iran.

Introduction: Prevention of pulmonary complications after coronary artery bypass graft is attended as a very important issue. The aim of this study was to evaluate the role of pulmonary rehabilitation before surgery for reducing the risk of pulmonary complications after surgery.

Methods: In a randomized clinical trial, 60 patients undergoing heart surgery were randomly divided into two groups A and B. Chest physiotherapy was performed before and after surgery on group A patients however it was done on group B's, only after surgery. Effects of preoperative pulmonary rehabilitation were compared between two groups, using spirometry and arterial blood gas (ABG).

Results: Thirty nine males (65%) and 21 females (35%) with mean age of 8.10 ± 9.56 were analyzed. The mean differences were statistically significant for predicted forced vital capacity (FVC) (CI 95%:1.3 to 8.7) and Predicted Peak Flow indices (PEF) (CI 95%: 1.9 to 9.4) of spirometry indicator, PCO2 index (of ABG parameter) (CI 95%: 1.4 to 8.9) and mean oxygen saturation (mean Spo2) (CI 95%: 0.6 to 1.7) of ABG index in two groups.

Conclusion: The performance of pulmonary rehabilitation program before surgery is recommended, as it may result in the reduction of complications of heart surgery.
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http://dx.doi.org/10.15171/jcvtr.2015.03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378669PMC
April 2015

Rapid Shallow Breathing Index Survey, a Predictor of non-Invasive Ventilation Necessity in Patients With Chronic Obstructive Pulmonary Disease Exacerbation: An Analytical Descriptive Prospective Study.

Iran Red Crescent Med J 2014 Feb 9;16(2):e13326. Epub 2014 Feb 9.

Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran.

Background: Patients with Chronic Obstructive Pulmonary Disease (COPD) are susceptible to respiratory failure which would ultimately lead to their hospitalization. Need to Non-Invasive Ventilation (NIV) is considered as the choice respiratory support in acute respiratory failure and is associated with a beneficial role in patients with COPD exacerbation. Hence, determining patients that would benefit NIV could be of great assistance.

Objectives: We aimed at evaluating the use of Rapid Shallow Breathing Index (a ratio determined by the frequency (f) divided by the tidal volume (VT)) in NIV requirement in COPD patients.

Patients And Methods: In a prospective descriptive study, ninety eight patients over 40 years old with documented COPD exacerbation who were referred to emergency department of Imam Reza hospital, Tabriz, Iran were studied. Rapid Shallow Breathing Index (RSBI), ABG parameters and APACHE II scoring were measured in each patient. Quantitative data were analyzed by Student's t-test and One-way ANOVA and qualitative data were analyzed using chi square (X2). Findings were analyzed with SPSS software version 16.

Results: Patients requiring NIV included 43.9 % of all studied patients. RSBI and APACHE II score with sensitivity of 94.8 %, (cut off point = 110) and 72 % (cut off point = 14) respectively, had high diagnostic sensitivity and also the ability to predict patients requiring NIV. None of ABG parameters solely played a significant role in determining patients requiring NIV.

Conclusions: RSBI and APACHE II score in patients with COPD exacerbation are of the ability to predict NIV requirement, as a predicting factor of Non-Invasive Ventilation requirement.
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http://dx.doi.org/10.5812/ircmj.13326DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3965862PMC
February 2014

Predictive value of capnography for suspected diabetic ketoacidosis in the emergency department.

West J Emerg Med 2013 Nov;14(6):590-4

Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Introduction: Metabolic acidosis confirmed by arterial blood gas (ABG) analysis is one of the diagnostic criteria for diabetic ketoacidosis (DKA). Given the direct relationship between end-tidal carbon dioxide (ETCO2), arterial carbon dioxide (PaCO2), and metabolic acidosis, measuring ETCO2 may serve as a surrogate for ABG in the assessment of possible DKA. The current study focuses on the predictive value of capnography in diagnosing DKA in patients referring to the emergency department (ED) with increased blood sugar levels and probable diagnosis of DKA.

Methods: In a cross-sectional prospective descriptive-analytic study carried out in an ED, we studied 181 patients older than 18 years old with blood sugar levels of higher than 250 mg/dl and probable DKA. ABG and capnography were obtained from all patients. To determine predictive value, sensitivity, specificity and cut-off points, we developed receiver operating characteristic curves.

Results: Sixty-two of 181 patients suffered from DKA. We observed significant differences between both groups (DKA and non-DKA) regarding age, pH, blood bicarbonate, PaCO2 and ETco2 values (p≤0.001). Finally, capnography values more than 24.5 mmHg could rule out the DKA diagnosis with a sensitivity and specificity of 0.90.

Conclusion: Capnography values greater than 24.5 mmHg accurately allow the exclusion of DKA in ED patients suspected of that diagnosis. Capnography levels lower that 24.5 mmHg were unable to differentiate between DKA and other disease entities.
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http://dx.doi.org/10.5811/westjem.2013.4.14296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876300PMC
November 2013

The Emergency Severity Index, version 4, for pediatric triage: a reliability study in Tabriz Children's Hospital, Tabriz, Iran.

Int J Emerg Med 2013 Oct 2;6(1):36. Epub 2013 Oct 2.

Pediatric Health Research Center, Tabriz Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: The Emergency Severity Index (ESI) has earned reliability and validity in adult populations but has not been adequately evaluated in pediatric patients. The aim of this study was to assess the reliability of the ESI version 4 and inter-rater reliability measures to evaluate the performance of nurses in the emergency ward.

Methods: Raters were part of the same team of pediatric emergency medicine team, including pediatric emergency medicine (PEM) physicians and pediatric triage (PT) nurses. Reliability and agreement rates were measured using kappa statistics. The measurements were compared with the admission rates, readmissions to the PEM division, location of admission and death as outcomes.

Results: Initially, PT nurses rated 20 case scenarios. Further in a prospective cohort study, 1104 children were assigned ESI scores by both nurses and physicians. The ratings of case scenarios showed a kappa value of 0.84. In actual patients, ratings showed high concordance with the physicians' ratings with the kappa value of 0.82 being in a good agreement with the nurses' ratings. The main area of discordance was detected in level 4 where 48 cases were triaged in higher levels and 25 were triaged in lower levels. The analysis showed the likelihood of admission clearly increased as the ESI score decreased (p<0.0001). There was a significant correlation between the admission status and triage level in both PT nurses' and PEM physicians' ratings (Spearman coefficient=0.374, 0.407; p<0.0001).

Conclusion: ESI scores assigned to the pediatric patients are reliable in the hands of experienced PT nurses and PEM physicians. The very good agreement between PT nurses and PEM physicians, demonstrated in this study, is essential in cooperative work in crowded referral emergency departments and helpful in challenging triage cases.
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http://dx.doi.org/10.1186/1865-1380-6-36DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3850684PMC
October 2013

Attitudes of emergency medicine physicians towards family presence during resuscitation.

Resuscitation 2013 Dec 15;84(12):e149-50. Epub 2013 Aug 15.

Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address:

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http://dx.doi.org/10.1016/j.resuscitation.2013.07.031DOI Listing
December 2013

Improvement of refractory migraine headache by propofol: case series.

Int J Emerg Med 2012 May 15;5(1):19. Epub 2012 May 15.

Emergency Medicine Department, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz, 51664, Iran.

Unlabelled:

Background: Several studies have been conducted on managing migraine headaches and developing effective medications for decreasing migraine-associated pain.

Case Presentation: Intravenous propofol was prescribed (10 mg every 5 min) for eight patients with intractable migraine headaches visiting the Emergency Department. The average pain score experienced by patients was recorded using the Visual Analogue Scale at the beginning of the treatment procedure and following the injection for 30 min (5-min intervals). The patients' reported pain scores decreased significantly (P = 0.01) from 8.87 ± 0.83 (CI: 8.17, 9.57) to 1.12 ± 0.83 (CI: 0.43, 1.82) before and 30 min following the injection.

Discussion: It seems that in the treatment of intractable migraine headaches, GABAergic receptors, compared to the normal conditions, have a lower activity status.

Conclusion: Because of the high tendency of propofol to GABAergic receptors, it probably changes this physiological condition by activating the receptors, which results in a significant pain reduction.
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http://dx.doi.org/10.1186/1865-1380-5-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3514246PMC
May 2012

Mucoepidermoid carcinoma of trachea in a 22 years old woman: a case report.

Pneumologia 2011 Jul-Sep;60(3):164-5

Tuberculosis and lung disease research center, Tabriz University of Medical Sciences, Tabriz, Iran.

Mucoepidermoid carcinoma is a relatively common salivary glands tumor. This tumor is characterized by mucus secretion, cell type can be intermediate or squamous. Mucoepidermoid carcinoma of the bronchi and especially trachea is very unusual. We are reporting the case of a 22 years old female who presented with main complaint of exertional dyspnea and stridor for about 2 month. Bronchoscopy examination showed a mass with smooth surface in trachea. After surgery a low grade mucoepidermoid carcinoma was confirmed by pathological examination.
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January 2012

Bronchoscopic diagnosis and removal of a ruptured hydatid cyst.

J Bronchology Interv Pulmonol 2011 Oct;18(4):362-4

Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Hydatid cyst is a common clinical challenge in endemic areas. Atypical clinical presentation and radiologic findings may occasionally lead to misdiagnosis. We report the case of a 22-year-old woman who presented with chief complaints of cough and hemoptysis of 2 months' duration. Bronchoscopic examination revealed a smooth, necrotic-looking endobronchial lesion, producing total occlusion of the superior segment of the left lower lobe. This lesion was completely removed using a flexible bronchoscope. Diagnosis of hydatid cyst was confirmed by pathologic examination.
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http://dx.doi.org/10.1097/LBR.0b013e31823504acDOI Listing
October 2011

Ventricular tachycardia due to flumazenil administration.

Pak J Biol Sci 2010 Dec;13(23):1161-3

Department of Emergency Medicine, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz-51664, IR Iran.

Flumazenil is one of imidazo-benzodiazepine (Anexate) which has been generally used as benzodiazepine competitive antagonist for the treatment of benzodiazepine intoxication during recent decades. Some has recommended diagnostic usage in ICU as well, for suspected benzodiazepine intoxicated cases. In this study we present a patient intoxicated with lorazepam who developed a ventricular tachycardia after receiving flumazenil as therapeutic mean, though the attack was appropriately terminated by administration of a bolus dose of Amiodarone. We believe that the ventricular tachycardia onset in above mentioned case is secondary to Flumazenil administration in susceptible patient with previous history of ischemic heart disease. Ventricular tachycardia has rarely reported as flumazenil side effects.
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http://dx.doi.org/10.3923/pjbs.2010.1161.1163DOI Listing
December 2010